Reconstruction of the Radiated Breast: A National Claims-Based Assessment of Postoperative Morbidity.

Objective: Implant based reconstruction rates have risen among radiation treated breast cancer patients in the United States. The aim of this study is to assess the morbidity associated with various breast reconstruction techniques in radiated patients. Methods: From the MarketScan Commercial Claims and Encounters database, we selected breast cancer patients who had undergone mastectomy, radiation and breast reconstruction from 2009 to 2012. We obtained demographic and clinical treatment data including data on the timing of radiation relative to breast reconstruction. We recorded complications and failures after implant and autologous reconstruction. We developed a multivariable logistic regression model with postoperative complications as the dependent variable and patient demographic and clinical variables including method and timing of reconstruction as independent variables. Results: 4,781 radiated patients who met the inclusion criteria were selected. A majority of the patients (n=3,846, 80%) were reconstructed with implants. Overall complication rates were 45.3% and 30.8% for patients with implant and autologous reconstruction respectively. Failure of reconstruction occurred in 29.4% of patients with implant reconstruction compared to 4.3% for patients with autologous reconstruction. In multivariable logistic regression, radiated patients with implant reconstruction had 2 times the odds of having any complication and 11 times the odds of failure relative to patients with autologous reconstruction. Conclusions: Implant based breast reconstruction in the radiated patient, though popular, is associated with significant morbidity. Failures of reconstruction with implants in these patients approach 30% in the short term, suggesting a need for careful shared decision-making with full disclosure of the potential morbidity. (C)2016American Society of Plastic Surgeons

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